{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T20:51:31Z","timestamp":1788555091378,"version":"build-2803163510"},"reference-count":163,"publisher":"MDPI AG","issue":"20","license":[{"start":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T00:00:00Z","timestamp":1697241600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Nosocomial pneumonia, or hospital-acquired pneumonia (HAP), and ventilator-associated pneumonia (VAP) are important health problems worldwide, with both being associated with substantial morbidity and mortality. HAP is currently the main cause of death from nosocomial infection in critically ill patients. Although guidelines for the approach to this infection model are widely implemented in international health systems and clinical teams, information continually emerges that generates debate or requires updating in its management. This scientific manuscript, written by a multidisciplinary team of specialists, reviews the most important issues in the approach to this important infectious respiratory syndrome, and it updates various topics, such as a renewed etiological perspective for updating the use of new molecular platforms or imaging techniques, including the microbiological diagnostic stewardship in different clinical settings and using appropriate rapid techniques on invasive respiratory specimens. It also reviews both Intensive Care Unit admission criteria and those of clinical stability to discharge, as well as those of therapeutic failure and rescue treatment options. An update on antibiotic therapy in the context of bacterial multiresistance, in aerosol inhaled treatment options, oxygen therapy, or ventilatory support, is presented. It also analyzes the out-of-hospital management of nosocomial pneumonia requiring complete antibiotic therapy externally on an outpatient basis, as well as the main factors for readmission and an approach to management in the emergency department. Finally, the main strategies for prevention and prophylactic measures, many of them still controversial, on fragile and vulnerable hosts are reviewed.<\/jats:p>","DOI":"10.3390\/jcm12206526","type":"journal-article","created":{"date-parts":[[2023,10,14]],"date-time":"2023-10-14T14:59:59Z","timestamp":1697295599000},"page":"6526","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":27,"title":["Ten Issues to Update in Nosocomial or Hospital-Acquired Pneumonia: An Expert Review"],"prefix":"10.3390","volume":"12","author":[{"given":"Francisco Javier","family":"Candel","sequence":"first","affiliation":[{"name":"Clinical Microbiology and Infectious Diseases, Transplant Coordination, IdISSC & IML Health Research Institutes, Hospital Cl\u00ednico Universitario San Carlos, 28040 Madrid, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8571-2124","authenticated-orcid":false,"given":"Miguel","family":"Salavert","sequence":"additional","affiliation":[{"name":"Infectious Diseases Unit, La Fe (IIS) Health Research Institute, Hospital Universitario y Polit\u00e9cnico La Fe, 46026 Val\u00e8ncia, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0665-557X","authenticated-orcid":false,"given":"Angel","family":"Estella","sequence":"additional","affiliation":[{"name":"Intensive Medicine Service, Hospital Universitario de Jerez, 11407 Jerez, Spain"},{"name":"Departamento de Medicina, INIBICA, Universidad de C\u00e1diz, 11003 C\u00e1diz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8171-6673","authenticated-orcid":false,"given":"Miquel","family":"Ferrer","sequence":"additional","affiliation":[{"name":"UVIR, Servei de Pneumologia, Institut Cl\u00ednic de Respiratori, Hospital Cl\u00ednic de Barcelona, IDIBAPS, CibeRes (CB06\/06\/0028), Universitat de Barcelona, 08007 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4859-4747","authenticated-orcid":false,"given":"Ricard","family":"Ferrer","sequence":"additional","affiliation":[{"name":"Intensive Medicine Service, Hospital Universitario Valle de Hebr\u00f3n, 08035 Barcelona, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9866-4259","authenticated-orcid":false,"given":"Julio Javier","family":"Gamazo","sequence":"additional","affiliation":[{"name":"Servicio de Urgencias, Hospital Universitario de Galdakao, 48960 Bilbao, 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Service, Hospital Universitario del Henares, 28822 Coslada, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Manuel","family":"Mir\u00f3n-Rubio","sequence":"additional","affiliation":[{"name":"Servicio de Hospitalizaci\u00f3n a Domicilio, Hospital Universitario de Torrej\u00f3n, 28850 Torrej\u00f3n de Ardoz, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5246-4876","authenticated-orcid":false,"given":"Javier","family":"P\u00e9rez-Pallar\u00e9s","sequence":"additional","affiliation":[{"name":"Division of Respiratory Medicine, Hospital Universitario Santa Luc\u00eda, 30202 Cartagena, Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-3083-7915","authenticated-orcid":false,"given":"Cristina","family":"Pitart","sequence":"additional","affiliation":[{"name":"Department of Clinical Microbiology, ISGlobal, Hospital Cl\u00ednic-University of Barcelona, CIBERINF, 08036 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